'Pharmacy coaching' an attempt at hometown health-care reform

Thursday

Jun 28, 2012 at 12:01 AMJun 28, 2012 at 10:58 AM

CIRCLEVILLE, Ohio - The U.S. health-care system can't just pop a pill to fix all that ails it. But in Pickaway County, population 55,698, Berger Health System is turning to the people who dispense pills as a way to improve community health at a lower cost.

Ben Sutherly, The Columbus Dispatch

CIRCLEVILLE, Ohio — The U.S. health-care system can’t just pop a pill to fix all that ails it.

But in Pickaway County, population 55,698, Berger Health System is turning to the people who dispense pills as a way to improve community health at a lower cost. The hospital is paying two independent pharmacies to teach recently discharged patients about their medications, hoping to head off noncompliance that can lead to costly and unnecessary hospital readmissions.

The hospital already has cut readmission rates by hiring a pharmacist to reconcile patients’ medications, ensuring that they won’t have any adverse effects, before the patients are discharged. Between August 2011 and March 2012, the hospital halved its readmission rates for patients with congestive heart failure, pneumonia and chronic obstructive pulmonary disease compared with the year-earlier period, said Aaron Kanas, the health system’s pharmacy director.

More than 1,000 consultations have taken place so far.

Now the health system wants to build on that success by joining with Schieber Family Pharmacy and Circleville Apothecary. Its goal: have pharmacists at those two independent pharmacies meet with 70 percent of discharged patients to learn more about their medications and how to take them.

If that goal is reached, the hospital will pay the two pharmacies a total of $75,000 to $100,000 each year in higher dispensing fees, a hospital spokesman said. The pharmacies also can be reimbursed $50 or so for each half-hour consultation with certain customers enrolled in Medicare’s Part D drug benefit.

The project, developed by Berger and Dublin-based Pharmacy Systems Inc., is designed to qualify for incentives built into the federal Affordable Care Act, the health-care overhaul whose constitutionality could be decided by the Supreme Court on Thursday.

“I firmly believe, no matter what the Supreme Court says, we are going to have to reform health care locally,” said Tim Colburn, Berger’s president and CEO. “And this is one small way to do that."

A similar “pharmacy coaching” pilot program in southwestern Ohio recently achieved a 15 percent reduction in health-care costs for Kroger and Cincinnati city workers with persistently high blood pressure. The costs of office visits and drugs increased, but more-costly emergency room visits and hospital admissions declined 40 percent.

Ernest Boyd, the executive director of the Ohio Pharmacists Association, said he thinks Berger’s project is unprecedented in Ohio in terms of the access it gives pharmacists to patient records. That information informs the talks pharmacists have with patients.

“The conversations that we have are as important as what’s in the bag,” said Boyd, citing research that about half of all filled prescriptions are not taken correctly.

Larry Schieber, who owns Schieber Family Pharmacy with his wife, Kim, said pharmacists there have consulted with a few dozen patients so far.

“We’ve found several instances where there were potentially serious complications that were going to happen,” he said.

He called the arrangement “break-even,” just enough to cover his pharmacy’s costs.

Linda Febes, 66, of Circleville, was hospitalized overnight in May at Berger for a urinary-tract infection. Afterward, she had a dizzy spell and fell at home. She thinks a bad reaction between medications might have been to blame.

Talking with a Schieber Family pharmacist who reviewed her medications was helpful, she said. “I take so many pills. It was just getting confusing.”

Berger is eligible for a federal program that allows health-care providers to save up to 50 percent on pharmaceuticals. As part of its new partnership with the two retail pharmacies, Berger restocks some of the drugs the two pharmacies prescribe. Those pharmacies then pay the hospital the higher price they typically are charged for those drugs. The hospital devotes some of that extra money to an enhanced dispensing fee — $10 to $20 instead of the usual $2 to $5. In return, pharmacists explain medication to patients.

The pharmacies also benefit from the hospital referring patients to them. The consultations are voluntary.

Berger invested $175,000 upfront to hire a pharmacist who reconciles prescriptions and for related information-technology upgrades. The partnership with local pharmacies will help it qualify to receive 1 percent of its Medicare reimbursement — about $80,000 — that is currently withheld as an incentive to meet quality benchmarks, including a lower hospital readmission rate.

bsutherly@dispatch.com

@BenSutherly

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